胆嚢管低位合流症例の臨床的検討 [in Japanese] Clinical evaluation of the point of the cystic duct. [in Japanese]
Access this Article
過去5年間の当教室における胆石症症例428例中, 胆嚢管が膵上縁より十二指腸壁を貫通するまでの下部胆管と合流する胆嚢管低位合流症例24例を経験した.これらの胆嚢管低位合流症例には種々の病態がみられた.すなわち, Mirizzi syndrome6例, confluence stone2例, 胆嚢癌2例, 先天性胆嚢管拡張症1例であった.胆嚢管低位合流症は解剖学的に, 胆嚢管が長く, 胆汁のうっ滞による胆石形成にMirizzi syndrome, confluence stoneをきたし, また胆嚢癌の発生をきたすものと考えられた.さらに, 胆嚢管合流部と膵管開口部との距離が短かい点より, 胆嚢管内膵液逆流を起こしやすいことが推測され, 膵胆管合流異常症と類似の病態を呈し, 胆嚢管拡張症を合併するものと考えられる.
The clinical evaluation of the point of junction of the cystic duct with the common hepatic duct by various cholangiographic procedures including an intraoperative one and by operative findings was performed in 428 surgical patents with biliary disease. A cystic duct inserted very low down with a correspondingly long cystic duct was found in 24 cases and the clinical significance of this abnormality was investigated by comparing these patients with 300 patients with cholelithiasis without low junction of the cystic duct. In the patients with low junction of the cystic duct to form a short common bile duct, several complications including gallstone pancreatitis (6 cases), Mirizzi syndrome (6), Confluence stone (2), gallbladder cancer (2), and congenital dilatation of the cystic duct (1) were found preoperatively. The anatomically anomalous junction of the cystic duct with the common bile duct may cause stagnation of bile and/or reflux of pancreatic juice into the bile duct and cause a condition similar to the anomalous arrangement of the choledocho-pancreatic ductal junction and also may result in difficulties at surgery.
- The Japanese Journal of Gastroenterological Surgery
The Japanese Journal of Gastroenterological Surgery 23(9), 2238-2243, 1990
The Japanese Society of Gastroenterological Surgery